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Perinatal quality improvement bundle to decrease hypothermia in extremely low birthweight infants with birth weight less than 1000 g: single-center experience over 6 years
  1. Dilip R Bhatt1,
  2. Nirupa Reddy1,
  3. Reynaldo Ruiz2,
  4. Darla V Bustos3,
  5. Torria Peacock1,
  6. Roman-Angelo Dizon1,
  7. Sunjeeve Weerasinghe1,
  8. David X Braun1,
  9. Rangasamy Ramanathan4
  1. 1Pediatrics/Neonatology, Kaiser Fontana Medical Center, Fontana, California, USA
  2. 2Obstetrics, Kaiser Fontana Medical Center, Fontana, California, USA
  3. 3Neonatology, Kaiser Fontana Medical Center, Fontana, California, USA
  4. 4Pediatrics/Division of Neonatology, LAC USC Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Rangasamy Ramanathan, Pediatrics/Division of Neonatology, LAC USC Medical Center, Los Angeles, California, USA; ramanath{at}usc.edu

Abstract

Normothermia (36.5°C–37. 5°C) at the time of admission to the neonatal intensive care unit (NICU) in extremely low birthweight (ELBW) infants (birth weight <1000 g) is associated with decreased morbidity and mortality, decreased length of stay and hospital costs. We designed a thermoregulation bundle to decrease hypothermia (<36.5°C) in ELBW infants with a multidisciplinary perinatal quality improvement initiative that included the following key interventions: dedicated delivery room (DR)/operating room (OR) for all preterm deliveries of ≤32 weeks with DR/OR temperature set 24/7 at 74°F by the hospital engineering staff, use of exothermic mattress, preheated radiant warmer set at 100% for heat prior to delivery, servo-controlled mode after the neonate is placed on the warmer, and use of plastic wrap, head cap and warm towels. A total of 200 ELBW infants were admitted to our NICU between January 1, 2014 and December 31, 2019. Hypothermia (<36.5°C) occurred in 2.5% of infants, normothermia (36.5°C–37.5°C) in 91% of infants and transitional hyperthermia (>37.5°C) in 6.5% of ELBW infants. No case of moderate hypothermia (32°C–36°C) was seen in our infants. Our target rate of less than 10% hypothermia was reached in ELBW infants over the last 2 years with no cases of moderate hypothermia in 6 years. Eliminating hypothermia among ELBW remains a challenge and requires team effort and continuous quality improvement efforts.

  • clinical research
  • infant, premature
  • intensive care
  • resuscitation
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Footnotes

  • DRB and NR are joint first authors.

  • DRB and NR contributed equally.

  • Contributors DRB and NR conceptualized and designed the study, drafted the initial manuscript, reviewed and revised the manuscript. RRu reviewed all of the maternal data, including the placental pathology of infants with hyperthermia; played a major role in implementing this quality improvement project as an obstetrician; and reviewed and revised the manuscript. DVB represented neonatal intensive care unit nurses, TP represented labor and delivery nurses, and SW, a key member of the resuscitation team, and were members of the quality improvement initiative for this study. They played a major role in the implementation of the plan–do–study–act cycle for this quality improvement project, and reviewed and approved the manuscript. R-AD had full access to all of the data and takes responsibility for the integrity of the data and the accuracy of the data analysis, and reviewed and revised the manuscript. DXB provided some of the demographic data and critically reviewed the manuscript for important intellectual content and approved the final version. RRa participated in the design of the study, drafted the initial manuscript, critically reviewed the manuscript for important intellectual content and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The institutional review board at Kaiser Permanente Southern California approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. See above marked item.

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